CMS wants all-purpose MACs to take over claims processing.
Your days of doing business with intermediaries and carriers are numbered.
What's next: The Centers for Medicare & Medicaid Services will transform plain old fee-for-service into a "premier health plan," the agency says.
Initial plans issued to Congress Feb. 7 would allow private contractors to begin bidding for the job of Medicare Administrative Contractor (MAC) as soon as next month. Current carriers and intermediaries would be officially closed out between 2007 and 2008.
Under the plan, Part A and Part B would be integrated into one, allowing a "single point of contact" for all Medicare claims-related business, CMS says. The reform also promises a "modernized administrative IT platform" that would store and manage all Medicare data in one centralized location.
The blueprint outlines goals to minimize and prevent disruption of claims processing. CMS has said it will start transitioning the durable medical equipment regional carriers first (see Eli's HCW, Vol. XIV, No. 5). More information is at
www.cms.hhs.gov/medicarereform/contractingreform/544563report_to_congress.pdf.
CMS will hold a special Open Door Forum on Friday, Feb. 25 to discuss planned DMERC contracting changes. Details on the forum are at
www.cms.hhs.gov/opendoor/022005/dmemac.pdf. There may soon be a new regional player on the publicly traded scene. Lafayette, LA-based LHC Group, which has 64 home nursing locations and four hospices, has filed a Securities and Exchange Commission document stating its intention to launch an initial public offering "as soon as practicable." The company also operates long-term care hospitals and outpatient rehab clinics.
LHC currently serves mostly rural markets in Louisiana, Arkansas, Mississippi and Texas and plans to expand to more rural markets in 14 contiguous states after the IPO, it says. "We have identified approximately 500 underserved rural markets in those states," the company claims in the SEC document.
LHC will either forge strategic relationships with hospitals or buy their hospital-based agencies outright. And the company may even purchase larger home nursing operations, it says in the filing.
LHC reports net revenues for its home care service line of $59.7 million in all of 2003, and $60.8 million for the nine months ended Sept. 30, 2004.
One concern: Joint ventures the company has with hospitals and physicians may trigger kickback or Stark law troubles, LHC reveals.
As of Feb. 18, CMS will consider a positive fasting beta cell autoantibody test as an acceptable diagnostic criterion for continuous subcutaneous insulin infusion pumps. The test is added as an alternative to insulinopenia per the updated C-peptide testing requirement (see Eli's HCW, Vol. XIII, No. 36).
To read the CMS program transmittal detailing the change, which is effective for services provided on or after Dec. 17, 2004, visit
www.cms.hhs.gov/manuals/pm_trans/R27NCD.pdf.
Crescent Capital Investments Inc. has finalized its purchase of Tender [...]
